 Hi ma'am, how are you? Yeah, good afternoon. We are Vasanthi Adhiprakash from NIT Group, this one. She is our regular host to all international events at Manipal Hospital. Yeah, Vasanthi madam, is it? Yeah, yeah, yeah. Vasanthi, just to introduce, Manila ma'am is like, I can say, close to Manipal Hospital, like whatever you propose her with new initiatives she always supports. So, it is like. Pleasure, pleasure being a part of this. Thank you. Hello, Vasanthi madam. You're not audible. Vasanthi ma'am, I'm not able to hear you. Let's check now. Perfect. No, I said, please, please don't call me ma'am. I met you earlier also. I know, I know. So, I said, please feel free to call me Vasanthi. I will, I will. It's always wonderful to have teachers and you, ma'am, Manila, you know, whichly deserve this. I've heard so much about you. Thank you. Thank you so much. Any particular questions or just casual, any relative opinions? Yeah, I mean, you know, given the context of, I mean, the fact that teachers are, many, many teachers are going to be watching this or are already a part of this. I can see they have, you know, joined this already. We had a set of questions, which is to say that, you know, you're key to the success because two ways. I mean, how do you even define success? But then the fact that you've had such a rich experience in the field of teaching and then what would you tell other teachers given the challenges they face today? So, that's what I'm going to ask you about. Okay, perfect. Because at the time it was started to the time now, so much has changed. So, yes, yes, yes. Looking forward. Yes, same here. As soon as Arun gives us the go ahead. Okay. The clock is struck 4pm. I guess it's time that we could start this program in honor of teachers. However, I'm just going to wait for a nod from our Manipal Hospital team colleague Dr Arun. Okay Vasanthi, we'll wait for another two, three minutes and we can start. Sure. As soon as you say. Yeah, sure. We can start. We crossed already 100 numbers, so we're not waiting. Yes. We have hit a century and that's of course a great reason to start this program. I know the people from the teaching profession across, let's say two continents have joined us today and that's wonderful. My name is Vasanthi Hariprakash. I am a journalist. I'm a person who loves telling stories and I've done that across radio, television, the digital world, television channels both national and international. It gives me great pleasure to welcome you all to this International Teachers Day special program with Namaste as we say in India. Manipal Hospitals, I'm thankful to you for inviting me every time to meet great people from across the globe. Manipal Hospitals, I must say for those who are joining in the very first time, particularly from the Indian teaching community and from Africa, it has been the front runner in creating public awareness campaigns. There have been many such initiatives. The endeavor is to change mindsets. It's also to provoke people into thinking for the welfare of the world around us. So here are some of the things that I'm going to be sharing with you. This is a wellness initiative especially that has been successfully run across many countries by Manipal Hospitals for doctors, nurses, the media and teachers across countries. The team is a firm believer in prevention is better than cure. Now, they also believe that healthy nation is possible with the aim of creating healthy students and who better to do that than healthy teachers themselves. I came across a very seemingly simple quote, but if you think about it, it said that a great teacher is the reason why ordinary students believe or start believing in extraordinary things and dreams. It is a teacher's power of motivating. It is the teacher's lived principle by which they set an example. So today's program is specially commemorating the contribution of all of you teachers to creating a healthy nation and thereby a healthy world. But the focus, which is why I'm going to be inviting very special speakers very soon, is how can we have great help for you because you carry on your shoulders quite a responsibility more than even many others of us because you are transforming the future. The theme of World Teacher's Day, ladies and gentlemen, this year that is 2022 is the transformation of education begins with teachers. So World Teacher's Day is an international day held annually on 5th October. Now those of you who are from India will say, but oh, we do celebrate this day on the 5th of September because a former president, the late Sarvapali Radhakrishnan who was a very dedicated teacher himself, his birth anniversary is marked as Teacher's Day. But what a coincidence that exactly a month later, which is on the 5th of October, it is World Teacher's Day. There is no newness if I even say the teachers inspire, guide, educate and mentor us every day. We are nothing really without our teachers. You and I put together, given credit to our own teachers. So now I have a team of doctors from Manipal Hospital whose presence I would like to acknowledge. We have Dr. S. Vidyadhera, HOD and consultant, spine surgeries, spine care, Manipal hospitals that is housed in Bangalore. There is Dr. Lieutenant Colonel Leena Shridhar, HOD and consultant, obstetrics and gynecology. She is from HOD in the department of academics and research. There is Dr. Ruchi Shruti, Kansai. Hello, Dr. always. Welcome to all. That's right. That's right. It's wonderful. I'm going to request our guests or those who have joined us to please mute their videos and audios unless of course you're going to be speaking. This just helps in a seamless experience. We have Dr. Ruchi Sharma as I was telling you, consultant clinical psychologist, Manipal hospitals. There's Dr. Chirag D, consultant, interventional cardiology, Manipal hospitals, India. There are also Dr. Navin Chandra, interventional cardiologist from Manipal hospitals. Now as very special guests, we have, I would say unsung heroes or probably there are people who know them and who are saying about them, but it's wonderful to be able to welcome them. We have Madam Manila Karvalo, principal DPS Bengaluru East. We have Rotarian. Yes, ma'am Manila. Wonderful to have you on this show today. Thank you for having me here. We have Rotarian P.P. Muhammad Tarikul Alam. Mr. Alam is assistant professor and chairman, department of English, university of Kamila, Bangladesh. Mr. Alam. Good, good, good evening. So, good afternoon to all. Am I audible? Yes, you are. Okay. Thank you, ma'am. Thank you very much for your wonderful presentation. Ma'am, actually, there is no electricity. Okay. So, for that reason, okay. So, I had to face a lot of challenges, okay, to join in the meeting. Yeah, the electricity has come. Yeah, yeah. Yeah, that is a part of it. So, ma'am, thank you. Yeah, thank you very much and greetings to all. Okay. From the core of my heart, all the respected participants from different regions on board, I express my heartfelt greetings to all from the core of my heart. Thank you, ma'am. Thank you. Such wonderful words, warmth, that's exuding. I mean, even without the electricity, you know, there was so much of light, I would say, because the teachers, you know, let's say, vision is just to ignite lives as they say. So, it is wonderful to have Mr. Alam here. We also have Ali Nafe Bandi from Malawi Teachers Association, Malawi. I'm not sure if we're being able to join at the moment, but we will wait because I know I totally understand that our challenges, particularly when we're joining from our homes or from, you know, from remote geographies. Having said that, I would now request, you know, having acknowledged the presence of our special guests that are media heads, whose presence also I would like to mark here, Solomon Agborim, National President, the Cameroon Association of Media Professionals, Mr. Moki Charles, Cameroon Association of English Speaking Journalists, there is Indi Maureen, President, Cameroon Association of English Speaking Journalists, Secretary General, Mr. Eric Oduar, Kenya Union of Journalists, Charles Mukula from Journalist Union of Malawi, that's Juma, Duminda Sampath, President Sri Lanka Working Journalist Association, NM Amin, President Sri Lanka Muslim Media Forum, Tanzania Media Women's Association, that's called the TAMWA, Executive Director, Dr. Rose Rubin, Madhukar Ramlala, Mr. Ramlala is from the Forum of Mauritian Journalists, Mauritius. So on that note, let's start a very special program. Let's hear from our, you know, unsung heroes first. You just now saw Ms. Manila Karvalo. Let me tell you a word or two about her. You know, her entire teaching career, it's been sort of a story of inspiration. She represents the Indian Teachers Association. She has four decades of experience in the teaching field. Now, first of all, Manila, I would like to ask you, your first day as a teacher, did you opt to be a teacher or did teaching just happen to you? What is your memory of your first day in this profession? Well, I know after my graduation, there was a general discussion at home. And the parents suggested me, I think teaching is the best profession for ladies or for girls. And those days, I think we were not going against our parents or whatever they said. We used to say yes. And of course, we love that because even when we were kids, we used to dress up like teachers, behave like teachers at home. So we used to play teachers role in the house and even in other places. So I willingly accepted this, but I never thought a day would come where I will have the institution. But I definitely enjoyed my journey and every day is a new learning experience. In spite of me being in the education for so many years, I still look forward to learn something new from the younger generation. And it's exciting, exciting journey for me. Yes, I think you've come to represent that facet of teachers that we know, which is perseverance, somebody who doesn't give up. Someone who has not given up despite the fact. I mean, of course, many congratulations on your heading the institution, something as well known as a Delhi Public School. Now I want to ask you that today, teachers face an enormous set of challenges, which is very different from, let's say the time when you entered, what was that the 80s? I'm guessing. So what are, let's say, the fundamental challenges that teachers today face now? The current generation of the children, what we are facing with the students is behavioural issues, which were not so much in the earlier days. And off late after pandemic, it has become even more. I think children were exposed to so many things during this pandemic, which they were not supposed to see. And two years of, you know, being in the house, not interacting with the others has created a tremendous problems in children. Now they're just having a pure relationship and they're addicted to so many, you know, abuse of drugs and systems like that. You know, even we as teachers are head of the institutions having a tough time, but I always feel that every organisation has difficulties, challenges, and we shouldn't shy away or run away from the institution, definitely they will come or a solution will be there to face these issues and sort of these issues. And we definitely require not of support from the parental community. And parents should accept if some schools say that, you know, there is a problem with your child, this is what we are seeing in your child. I think we shouldn't have parents saying that no, that is not my child and having refused the total, whatever we say from the school side, they need to accept it. And because school is a place, you know, educating the child is a joint venture of both the parents and the teachers. Teachers alone cannot do any magic. Of course, you may deliver what is there in the book, but child is always there with the parents, even after he leaves the school, I always tell the parents, child may be there in the school for about 10 years or 15 years. After that lifelong, the child is with you, even when the child grows older, still the child to the parent and the child is always with there. So we need to mould and modify the child's, you know, behavioral issues according to our culture, our traditions, that is what is required, definitely. And a lot of challenges are there, but at the same time, schools are getting equipped to handle these challenges. That is what I can say. Very optimistic. You're such an optimist, Madam Manila. So according to what you shared, and I just want to give a quick gist to our our guests, people who are attending this as delegates, you've spoken about behavioral issues, a change from that time to now. We also, you know, somewhere along the line, access to digital devices, the distraction that comes along with it, the post pandemic scenario, all these are making it tougher, probably harder for teachers to cope with, you know, handling a class of students, something which is which is probably new to this decade. I want to request all our guests that please use the chat box. You all are teachers. I don't need to tell you, you must be good at writing. I can't give you a blackboard here, can I? But I'm certainly giving you a chat box as a host of this show. So please tell us what your name is, which is your school, what region, what country, and what is the toughest part of being a teacher now, you know, depending, relating to when you enter the profession to now, what is the difficult thing that you are facing? We would like to hear from you. So please use the chat box. All that you have to do is to just go to the chat window at the bottom of your screen, start typing all the things which I asked you. Now, one final question because we have many guests. So I would like to ask you that in terms of health, because Manipal Hospital is organizing this just so that healthy teachers make a healthy students and thereby a healthy nation. Now, in terms of dealing with the health of students you have spoken about, but what are the health challenges that teachers face Manila? I must congratulate first of all Manipal Hospital because they are in and out for all the teachers, you know, supporting them with a good health. Definitely it is there. There are a lot of work in this regard. But when it comes to teachers, you know, I think the mental health is more important because teachers are having a lot of challenges face these days. It's not like from the school side, even back home because they need to have, you know, balanced life, you know, managing family life and workplace and the current scenario that is happening. So everywhere the teacher needs to be updated and, you know, manage the issues. That is what is very, very important. And I think when the teachers, the teachers especially who are there for many years, I think it is during the Manipal stage also, you know, ladies are having a lot of issues that is the most, you know, maybe they're towards the end of the retirement stage, but having spent so many years of their career in the same school and towards the end of retirement, if they're having to face certain problems, I think that's where we need to help them out because a large number of teachers are in that segment these days who are having these issues. And of course mental health is something that we need to look into because teachers are bombarded from all over. It is not only from the student side where the children, you know, refuse to give respect to some teachers, you know, whatever we do. Sometimes it is like that. The society has, you know, because the influence with the society or the fear, it happens. And at the same time, even the parents, you know, of the children, you know, that regard and respect what we used to get as earlier in the Gurukula system is definitely gone down. But of course, I believe that it depends upon you how you handle and manage the situation as well. And then again, you know, when we have a large media, I think we need to make sure, you know, media media also speaks well about the teacher, not only on the teachers their celebration, but throughout. Because teachers are the strong pillars of the society who mold the children and build the society. I think they need a lot of support, moral support is required. You know, there could be one or two, three teachers who are making mistakes, but it cannot be branded for the entire teaching community. So that we do. I agree. We need to take really a balanced view on this and the media certainly has a big role coming from the industry. I would like to say that we have had messages from Sandhya, from Greenville High School, Harohali. There's also Poonashree, Dev, Mamta Sharma and Sneha. So one of the things that they are communicating is that the chat is disabled. I don't know why you're facing this problem. There's also Sneha from DPS South, Bangalore Challenges are how do you satisfy a student? They take a teacher as an employee and not like a mentor, right? Very, very valid point, Sneha. You're going to probably, I mean, this is a program that is meant to address the health issues of teachers, but we'd still like to hear from you and I'm glad you're sharing this. Because all this, as Madhu Manila also shared, adds to the mental health challenges that teachers face, there's lack of respect and all these issues that you talk about. Now in the chats there is, I don't know whether we are able to, you're able to post questions on the chat for some reason if that's not possible, please make use of the Q&A button on the bottom of your screen, Q&A. You can post your questions or comments there. So while thanking Madhu Manila Karvalo, I am going to invite our next special hero of this program, someone who greeted us so warmly despite an electricity cut at his place in Bangladesh. He's been able to join us. So Rotaryan P.P. Muhammad Tariqul Alam, he represents a Bangladesh Teachers Association. I want to ask you, you have this very smiling countenance when the situation gets really bad with, say in a classroom scenario, how do you maintain your temper, how do you control your anger? Okay, thank you. Thank you very much. Pashanti ma'am, okay, for your wonderful presentation and greetings. Okay, so on the very eve of International Teachers Day 2022 program for Teachers Addressing Health Issues by Manipal Hospital India. First of all, I express my heartfelt gratitude and thankfulness to the hospital authority who have given me these ample opportunities and pride privilege to say few words before the scholarly participants and nation builders, unsung heroes of the world. That is our respected teachers from different parts of the world, love, respect and salute to you all. Ma'am, so actually managing a classroom is very challenging for a teacher because in a classroom, different section of students, different cultural minded students, they have come together. So to manage those people, the teacher, it is a very challenging task for a teacher because you know, teaching is an arch. So the teacher has to play artistic activities in the classroom by maintaining discipline and smiling appearance in the classroom. And when in Bangladeshi context, you know, in our classroom, lots of students are available in our classroom, you know. So this is a very densely populated country, you know, and in our classroom, 50 or 60 students, we have to manage, okay. It is a very tough, but whenever a teacher, okay, he make his lesson very wonderful and try to, he would try to give the lesson to his student in a very wonderful and new or innovative things whenever he would offer to the students. The students feel very delighted to receive the things with full of attention and they become very patient, okay, in the classroom to listen to the lecture of the teacher. So in that case, teacher must be very innovative, very creative and some extent he has to play some role in the classroom, okay, to manage a large classroom. Only then it will be possible to deliver a wonderful lecture to make people or make students understand the lesson in a very fantastic way. And in my classroom, whatever I follow, always I try to give a kind of inventive things, okay. So very simple things, I always try to give the students in a very artistic way, very simplest way so that the student can, okay, enjoy the classroom, okay, and they can understand me in a very wonderful way. So I always try to make the hardest things very easier to make the students understand, okay. And that I following during the last 13 years of my teaching career. Thank you ma'am. I wonder what it must be to be in your classroom, Mr. Alam. I want to ask you one last question that while you spoke of challenges in Bangladesh, given similar situation densely populated and you know more children to handle, all this obviously creates a lot of stress. But are there any specific health challenges that teachers face in Bangladesh in your region that you would like experts, let's say from those at Manipal hospitals to address or think about? Okay, thank you. Thank you very much for your wonderful question. It is a multimillion dollar questions, I think, okay. Because, you know, in our country, almost 18 courts of people live in our country. And we have lots of institutions. And many of our teachers, okay, they are facing lots of health issues. Okay, if I say we had to work hard because, you know, just right now I have mentioned that we had to deal with lots of, lots of number of students, okay. So the teachers had to face lots of challenges. Like, sometime they had to, they had to Easter for a long time in their institutions, like schools, colleges or universities, okay. So, actually, we sometimes we cannot maintain eight hours of each hour, okay. We had to work for 15 hours also, okay. You know, sometime, okay. So not eight hours, sometimes 12 hours, 11 hours. And even after going back to our home, we had to deal with or we had to evaluate our answers of the students, their assignment, their different types of exam scripts we had to, okay, evaluate. So that is a pressure. And since I have been teaching in tertiary level, so sometime, okay, we had to work for a long time, okay, sitting in the same chair, okay, for a long time. And sometime we face some neurological issue, like back pain, then neck pain, body ache, okay, then sometime headache, okay, problem. And in our country, you know, in different institutions, okay, there is no comfort zone for the lady teachers, female teachers, okay. Yeah, it is a serious in our country. And one washroom is used by 15 teachers. And some extent you see, okay, the female washrooms is used by the male counterparts also, okay. It is a serious, okay, I think unhygienic atmosphere, okay, for the teachers. And sometime, okay, there is no comfort zone for the female teachers in our country. Whatever I have observed, okay, in my short period of teaching career. And you see, the teachers actually the teachers position in our country is not so much respected, okay, respectable level, okay, status in respect of other profession, okay, what the amenities the other professional persons they are getting, okay, the teachers as a university teacher or school teachers or other, yeah, we do not get socially status. Suppose, you know, in a program or in a function whenever we go for participating any kind of function, we see the administrative personalities or the political figures, okay, they are taking their position in the first row. But there is no position in the first row for the teachers. So that is not very good things, I think, okay. So as a teacher, we feel very much uncomfortable. So that is one thing, one problem. And suppose for the female teachers, okay, some extent we see lack of proper balance between family life and their professional life or working hours, okay, there is a huge gap. So mental or psychological problem is faced by the female or male teacher, both okay. And sometime we suffer, we are suffering from some financier insecurity problem in our country. Okay, that also has I guess health repercussions Mr. Alan. I can't help but think that it's so relatable. It's what you're saying holds good, I'm sure for many of our teachers who are facing some similar situations, wherever they are, whether they are in India, Africa or in their own countries in Africa or in Bangladesh. But I really appreciate you and I'd like to thank you for speaking so much of the heart and speaking so frankly and candidly, even on behalf of the women teachers, it's almost like you've been the voice of the teachers in your country. I'd like to thank you for this. And I would also know that people from the Manipal Hospital's team, the doctors were joining in, must be making their own notes, the team, in terms of preparing a certain strategy in the time to come. So thank you so much once again, Teacher Alam. Very, very proud of the work you do. Thank you. Thank you sir. But please stand by because there are of course many comments and messages that are coming in. We are going to be inviting Dr. Lieutenant Colonel Lina Shridhar, but a very quick acknowledgement of all our teacher friends who've been, there have been so many, like for instance, Antwi Bussakio Richard, who says from Akkim Chiraghana, one of my challenges as a teacher is inadequate teaching and learning materials. There's also Feggy Mfasi from Malavi, who says hypertension is mostly common among teachers, triggered by the conduct of students and parents as well as school administration. Yes. So I can see that Dr. Lina is ready. She's making sure that her mahal is also ready. So I'm going to come to you, Dr. Lina. As I mentioned to our audience earlier, you're the HOD Department of Academics and Research of Spectrics and Gynecology. So, you know, straight to the question. We don't have much of time and we have all of you experts. I want to make use of that. Now 90% of teachers are said to be women. I think this is true across the board. Now, as this column was mentioning, they stand for so long, they don't have access to clean washrooms and toilets. There is mental stress. They work long beyond the thing and also find it hard to juggle family and work. So what are your tips that you would give teachers? Okay. Before I just just tell those tips, can I just say a small thing? Just a couple of months back, I had a teacher. She came very smilingly and she said, look, I had two children and I've never seen a gynecologist after my last baby, which was about 12 years back. So it was almost as if, you know, she was being apologetic about coming there and so I said, okay, so what's the problem? So she said, I have this, you know, vaginal discharge and I was sitting in the, you know, the common room, the teacher's room and just another teacher who has been your patient said, why don't you go and get a check up? She said, otherwise there's nothing wrong. Every time she would stress by saying, otherwise I'm actually fine. Yeah, I'm absolutely fine, but there's this discharge which I really can't pinpoint why it happens. And, you know, she'd read up all about it. This is the physiological discharge. It can be a yeast infection. It can be a part of a urinary tract infection. Probably again, she could find reasons that I've been standing for too long. I've been having a very stressful time. So she found all that and every time she would say, you know, I've never required to come to a gynecologist after I had my last baby, which was 12 years back. You know, I just put in a speculum examination. I asked her, have you had a pap smear done every any time she says, no, I haven't had. And when I put in a speculum, I could see something which I was, you know, clinically did not look healthy. We rushed her in for a biopsy. She, you know, couldn't really understand because there were always things, though, there's a, you know, meeting which I have to attend. There is this exam which is coming up. I've got to teach them. And she was, by the way, an English teacher. So she was very particular about how she taught her children. Fortunately, this was stage one, very, very early stage of cancer of the cervix and it was picked up. She was 42. And she's been operated. Happy to say she's doing very well. So that's a good outcome. So I just started with this, you know, Vasanthi, why I started with this was just to tell you, to tell our eminent teachers here on this platform, you're doing wonderful work. And, you know, extraordinary work. You're excellent in your field. You have a very awesome responsibility, you know, on your shoulders. But nothing is going to be possible if you yourself are not healthy. Somebody down the line, you know, your, your, your track, your beautiful track, your the train is going on the right track, it's going to get derailed one day or the other. So you have to decide what are your priorities. Once your health is with you, you can do everything, whatever your plan for your for the children that are under your care for whatever extra responsibilities that are going to be put on your shoulders. So coming to the question that you said, standing for too long, having classrooms, sorry, having washrooms that are not woman friendly, I feel you should take a stand. You have to drink enough water, your body needs water, urinary tract infection happens when you hold on to the urine for too long. And that invariably happens when you feel the washroom is not good. When you feel okay, look, I'll finish this and you know, I'll go home and once and for all, I'll drink less water during the time when I'm in the school. That is all wrong. You drink less water, you are dehydrated, there is more chances of your bladder, you know, bacteria getting into the bladder and having a flare up of urinary tract infection. Women are more prone to urinary tract infection per se, because of the short urethra. And because of certain physiological changes that take place during, you know, their entire life from the reproductive age group, say up to 45, after that post menopause, there are certain body changes, there's a lack of a hormone called estrogen. So they're a little more prone to it. So first and foremost, you have to stand for long agreed, you have to do your work agreed. But stand up and ask for good washrooms. If you have existing washrooms have amongst yourself, a person who's going to ensure that their washrooms are kept clean, you can use, you know, nowadays we have certain things like a pee safe, we have, you know, toilet paper, you can use on the seat, you can spray it, right? So you can prevent yourself from getting urinary tract infection. In fact, I always say that while the English toilet may be something, you know, as per our convenience, but the Indian toilet, you know, where you really don't touch anything is actually much more hygienic. But wherever you are in whichever school you are, whichever institution you are, make sure that the washrooms are safe. Take a stand, insist, involve your principal, involve your, you know, people who are in charge and make sure you have good facilities, do not hold on to your urine, drink enough water. So when we talk about enough water, it is 10 to 12 glasses, add two more glasses during the summer. And this is very important, especially in the places which are cold, in winter we tend to drink less water. And we consciously or unconsciously tend to hold on, you know, to prevent ourselves from going to the washroom, which is wrong. So these are some of the tips I would like you to, you know, start right away. Thank you. Thank you, Dr. Alina, very pertinent tips and very doable. I mean, this take a stand, have enough water and don't hold on, you know, the bladder. Yes, yes, hold this. And of course, the incidence of cancer that you mentioned, getting a mammogram done or a pap smear done, teachers often tend to put themselves as a last priority because there's so much focusing on the students that this can get overlooked. Thank you. Thank you so much for sharing. What I tell Vasanthi, I tell them, see, it's very difficult to remember all these things. So what you do is when it's your birthday, instead of spending that mandatory, you know, amount on a wonderful gift for yourself or telling, you know, your family, okay, let's have a great party, etc. You know, you're tying your pap smear, right, after the age of 40, go for a mammography pap smear, as soon as, you know, you're sexually active or, you know, even spend the word around in your family that you must get a pap smear done, mammography after age of 40, and a simple ultrasound of the pelvis. I think this is very doable. It can be incorporated into regular health checkups that all people are supposed to take. And as teachers, this is important, you know, to do it annually. So time it with your birthday, then you'll always remember that you've got to get it done. Yeah, a birthday and that too, of course, when you're starting a fresh new innings. Thank you, Dr. Leena. The comment box, you can, I'm sure you can find some of those questions. We will see how much time we have. Otherwise, the team will be getting back with responses. Meanwhile, I would like to invite and welcome Dr. S Vidyadhara after Dr. Leena has given us such, you know, very important not to be deletives. I hope teachers are noting those points down. Now, Dr. Vidyadhara is the HOD and consultant spine surgery, spine care, manipul hospitals. Now, Dr, you have heard the previous speakers talking about standing problems of teachers. We've seen that. I mean, even the image is of something where teachers stand for us for our sake. What do you have to tell and share with them? Yeah, thanks, Jayanti. I think I'm going to briefly put a, that is it. Yes, we can see your screen. Can I share the screen? Yeah, you can see. So good afternoon, everybody. And I am here to talk about basic back pain issues common in teachers. Being a son of two teachers, I think there cannot be any other better student who can talk about back pain that I have seen my parents suffer. And this is all that I have. I'll quickly summarize. She makes basically eight out of 10 of us, whether you are a doctor, engineer or a teacher or a banker will suffer from back pain at some point of time in life. It's not untrue if I say that at least in a place like Bangalore where sitting is more than standing, which is still an epidemic. And it's a big business because everybody, every hospital, every doctor wants to sell something or the other in the name of this helps for back pain. And if you make it available online, it sells better. A lot of myths that lifting heavy weights causes back pain. Bed rest is the best way to cure bad back. Investigations like MRI will give you the root cause of back pain and that most back pain patients will need eventually a surgery, which is not true. And that is the fact that many people suffer and no two doctors will talk the same language. You go to 20 doctors, you'll get 20 opinions. Basically, our spine is comprised of two bones vertebrae separated by an intervertebral disc, which is a cushion. And there is a two facet joints which will help us in bending forwards, backwards, sideways and twisting. This is not all. There are ligaments holding the two bones together and the muscles which will contract and relax to give the mobility to the spinal column and the spinal cord, which goes from the brain to the tail tip, giving branches to every level, which go down the hands and the legs. Now, what can go wrong? The most common thing which goes wrong to cause back and neck pain is the disc, which is the kingpin maker. And this disc when we are born is in liquid consistency, becomes jelly, becomes solid by just losing water and proteins. And this process is called degeneration of the disc. And this is the schematic diagram of the disc interspersed between the two hard bones. It is the disc is like a balloon filled with water, mouth tight, kept in between the two bony surfaces. And this is a very good shock absorber in a child. Whereas as we grow old, the liquid water becomes lesser and the back becomes balloon becomes thicker. This is definitely a stiff balloon, and it is prone to injuries and the liquid coming out can cause irritation of the nerve root going down the leg, as well as mechanical compression of the nerve, which is going down the leg causing what you call as sciatica or slip disc or disc prolapse. Now, friends, this is the MRI of a child. You can see those watery filled balloony discs. And this is a 80 year old male, no back pain, and you see these black discs with no water in them. So given 70 years, this 10 year olds MRI will look like this 80 year olds MRI and every single disc first degenerates, losing water and proteins, then it bulges, then it ruptures, the nucleus pulses coming out, the gap becomes lesser, the bones wobble on one on top of the other, producing extra bones bridging the two bones together. And coming to the examination, when we see patients in the out patient with back pain and neck pain, we should always think that pain is not your enemy. It is your friend. It is telling that there is an underlying physical injury and there is a psychological expression to it. Sometimes the injury is more physically. Sometimes it is expressed more because of the underlying psychological condition because stress in any form causes amplification of the pain perception. And also when we are under stress, we don't realize that it is because of the stress that you're feeling the pain more. Now, there are red flags like if you're in a school teacher, you rarely get a child with back pain. And if there is a child with back pain, you think of TB or some tumor in the spinal column. And in an elderly, definitely nobody goes to a doctor for no reason. If they would have tried all the other massages and oils and hot bags, and if it is not reduced, then only they go. So we always consider an elderly 50 or 60 year old coming to a doctor as a red flag. In an elderly, say your parents are old 60, 70 with some sort of cancer history or some patients on steroids, the bones are weak, even a slightest fall in the bathroom can cause osteoporotic fracture in them and it is a red flag. TB is back, tuberculosis of the spine. So anybody with back and neck pain with fever and loss of eight loss of appetite, you think of TB spine and somebody with neurological symptoms like numbness, weakness of limbs is a red flag for us. And pain usually in the spine becomes better when you're lying down at rest and better by taking painkillers. And if somebody says it is not better by rest or painkillers, think of again infection and malignancy. And quickly you can check yourself. If you're able to walk normally in front of the mirror, walk on the heel, both heel and walk on tip toes, then your neurology is normal. So there is no red flag. If there is one of these is abnormal, you go to a doctor. But having said, most of us have back pain and not everybody needs to go to a doctor. And once you go to the doctor, doctor is in a fix as to which test to ask for. Because there are so many tests in the market that I can empty anybody's pocket. And patients themselves come and tell me that, oh, I have got spondylosis from 1996. I got a slip disk from 2011 extra bone crack in the back, all sorts of things because doctor like me would have driven it into their heads. And we may see also that there is a extra piece of bone, there is a defect in the bone, there is a extra limbus vertebra, there is a irregular bone. And these need not cause back pain. Maybe your grandfather had this and he never knew this. Today you have X-ray MRI to see this and get scared of it. This is the study done by the insurance companies on back pain evaluation and treatment. They found that in 10 years time, the cost of imaging, cost of medications, cost of injections and cost of surgeries has increased by five times. And this is not accompanied by improved patient outcome or disability. Now, the insurance companies then woke up and re-analyzed as to what is going wrong. If outcome is the same, why should we spend five times more money? They found that two thirds of the spinal MRIs were not supposed to have been asked. And spine surgeries were where the highest, where the imaging was highest. So I always tell my patients, you safeguard your interest. This blanket doesn't matter who's sleeping next to you, you safeguard yourself. So should we ask for an X-ray? Obviously no, the answer is there. We need to ask for an X-ray if there is a child with back pain, with somebody elderly with back pain or incapacitating, somebody coming on a stretcher, unable to get up at all from back pain or severe pain in case of a road traffic accident. All the rest can wait for three weeks. And mainly the X-ray excludes bony pathology. X-ray next step is MRI. It is the gold standard. You see minutest disc degeneration or loss of water to big slip disc, to bone slip. And this diagnosis, MRI diagnosis, even infection and cancers in this spinal column earliest. And this is interesting study by Eugene Kerrige from USA, which proved that these are all the findings in normal volunteers. He got hold of 1,478 normal volunteers, did the MRI, who never had back pain. And he found that few people had these slip discs, disc degeneration, the annular tire and the high intensity zone. And this is the graph that he had given that normal volunteers had 60% incidents of degeneration of disc, 55% of disc collapse or slip disc, 30% annular test and 25% high intensity zone. In other words, he concluded that more than 80% people had more than one finding if you do MRI. If you were to treat MRI, you are like this hunter who is searching for the prey and he's searching. And if you had to treat everything that you see on the MRI, you are like this lineman who doesn't know which wire is faulty. And friends, I divide treatment of back pain into two parts, treatment when there is pain and prevention when there is no pain. After all the advances in science, we today believe that it is the nature which heals not the doctor, not the spine surgeon, not the neuro, not the orthopedic surgeon. It takes time and if you wait for three months, 90% of back pain neck pain heals by itself. But how many of us can wait? We have too many options and we have too many reasons for not waiting. So bed rest is the next, which is proven to be delaying recovery if you take bed rest for more than two days, which is contrary to the popular belief. At least in India, I can say friends that it is the fifth largest religion. Like after Hindu Muslim, Christian Sikh, bed rest is the fifth religion. Both patients and doctors believe in it equally well, but it is known to cause delayed recovery. Belts and collars and corsets, which are not good, because more than seven days of its use has been proven to be causing weakness of the muscles that are there underneath the belt. No physiotherapy actually helps recover fast. It only gives temporary relief, even a hot bag would do. And what to do, what not to do, even if you don't know somebody, he would tell you, don't do bend forwards, don't drive to wheeler, don't sit on the ground, don't use Indian promote. You know, so many don'ts, but who tells what to do? Only most people would tell you take strict bed rest, complete bed rest. Now, what is, that is wrong. In fact, today we believe it is active rest wherein resume normal daily activities and don't do something that increases pain. So who decides, patient decides. It is his body, somebody who is having no pain in standing and walking can as well stand and walk rather than sleeping when he's having more pain. And pain friends is protective, respected, be within its limits. It will tell you what you can do and what you cannot or what you should not. So rest is equal to rest. It is active rest, which is the key in today's world. Pain killers on demand. If you have to go for a wedding, please do take a settlement of a paracetamol and go so that your photo comes nice. Antidepressants in chronic pain have definite benefit and I always give anti-depressant people for people with more than three months of back pain. Now, when do we do actually MRI and surgery? Both share the same indication. If somebody has weakness of limb or trunk, gross weakness, or loss of control of urine and motion, here I sell surgery. It's an absolute indication. Time is money. The earlier you release the pressure from the nerves, the more the chance that the patient recovers. And in chronic pain, it is the functionally disabling pain for more than three consecutive months wherein we say that it is the patient who buys surgery and this becomes a relative indication because pain is subjective. No two people can have the same intensity of pain with the same injury or insight. Friends, these are the only three indications and spine surgery is not a cosmetic surgery. It is not done to make your MRI look better or your disc prolapse to be removed. Left alone, the back pain is an episodic disease. It comes, it goes, it comes, it goes and leaves behind significant amount of residual pain and the frequency with which it comes becomes more and more with time. And a flexible child becomes stiff adult by virtue of inactivity of the muscles and the ligaments in front and back of the spinal column, not because your liquid disc is becoming jelly and solid. And this stiffness causes disc relapse causing back and leg pain. And if you want to really prevent this, you need to get back flexibility. Friends, our body is like this car. If you don't start it every day, it gets people to push it and start after a week. And if you keep it in one place without starting for a month, you need to get a mechanic and restart. With all the evolution of humans or the animal kingdom, we became the most successful people because of us being able to stand direct. But somewhere down the line, I think evolution has gone wrong and we are back to where we were. Friends, yoga is number one preventive measure along with Pranayam, the breathing exercises. Swimming is the next best. Iman, personal choices. I think if you can quit smoking, that will be the best because smoking is known to cause accelerated disc regeneration and slip disc. And weight gain for obvious reasons is not good for your back. And when you sit for preparing the projects, sit straight, look straight, and more often than not take breaks and get up and walk, do some stretches and sit again. Movement is life friend, whether it is the heart, lung or the spinal column, everything needs movement. Full range of movement, at least few times a day. And don't do MRI unless there is an indication for surgery. Yoga is the best because it not only tackles the functional physical disability, but also treats the depression, if you know the right way to do it. It's like a recurring deposit. If you do yoga every day, one hour, I think whole life will enjoy the benefits of this yoga. And to sum it up, it is not because it is a small disc that it is normal. Even in a small disc, if it is troubling for more than three consecutive months of pain, we do offer surgery as an option. It is not because it's a large slip disc that you need a surgery. If it is a capacious canal, spinal canal, it may not do any bad. And you may not have any symptoms and you don't have to do surgery. So treatment is for the symptom, not for the MRI findings. And surgery, no matter who says what, has no 100% success rate in this world. And conservative treatment, friends is reversible. Surgery, no matter how small leaves behind a scar. So think conservative, stay conservative, do thorough workup if you know what you're looking for and don't get over treated. And surgery only if you have weakness of limbs, urine motion loss of control, or intractable, unrelenting pain for more than three consecutive months. Rest all, think non-surgical. In three lines, the summary of the talk, pain is protective, respected, flexibility is the key, maintain it, and don't do MRI and surgery unless there is one of the three indications. And not to say that you have to live with back pain, it can, once it becomes chronic, that is more than three months, it can rarely be cured and only be treated intermittently like diabetes and asthma. Friends, there is no viagra which can reverse these changes of the degenerative disc disease into a pediatric, nice-looking watery baluni discs. And what God wanted us to do was, like this farmer, sweat it out in the hot sun, end of the day, any food, any mattress, any pillow. Farmer would get good night's sleep and the next day he would be fresh, energetic and happy. But today what we are doing is sitting in AC rooms, keeping the body cold and only the brain is heated up. Everything we have extremes of emotions and then we keep getting somatic manifestations of stress, disorder like lack of sleep, dizziness, gidiness, chest pain, palpitation, back pain, neck pain, acidity, constipation, menstrual irregularities. You name it, you have it. And ultimately, we go to doctors for each of these symptoms, the so-called symptom-specific, super-duper specialists like with the other. We have 250 of us in this main manipal at Old Airport Road. And you can get, even if you have a weird symptom that there is no super specialist, you try to RHR, they'll get a new one from UK or US. So we are so fast and so advanced that each one of us, if we give one or two medicines for one or two problems of yours, you'll end up taking 10 medicines in the morning, 15 in the afternoon, 20 in the night. We can make patients out of you. So friends, there are three choices for us. Go back to grandfather's farm, be a farmer, or do one hour of yoga or stop cribbing, start enjoying pain and keep changing doctors and for entertainment. Anyway, we are now acquiring almost all hospitals and anywhere we go, I think you are safe with Manipal hospitals. I honestly feel that we are over treating back pain and it is high time that we back off. Thank you and over to you, Jayanti. Thank you. Doctor, you've got everything right except my name. My name is Vasanthi. Second time you picked it up, first time I think you missed it. No, no, I very much was aware but I thought you should not interrupt a doctor whose speech has begun. My pleasure, sorry again. Not at all. I think I have overshadowed the question and answer times. I want question and answers. I'm afraid that's right, in terms of time but the good news is that you have covered so much within this short talk and what an engaging, compelling way you have of telling your story. You should in fact be in my place, a storyteller. Thank you once again for sharing all this. I'm sure you've left a lot of scope for questions for people to even take the first steps to transform their lives and save their back quite literally. So with that being now moved to Dr. Ruchi Sharma. She's a consultant, clinical psychologist, Manipal hospitals, New Delhi. Dr. Ruchi, with your permission, let's just take a look at some of the people who have been writing in. There is Bong Sakwa, a teacher participating from Cameroon. There is Faggy M Fasi, whose question I had put out a little while back, which is that hypertension is common among teachers triggered by the conduct of students. There is Rosamma from Mount Carmel Central School, Mary Hill, Mangalore, India, who says these days children are not emotionally strong because they're facing many problems in their families. How do we as teachers give support to them? And so there are so many of these questions and I would like to thank all our teachers who are putting in their names. Please continue to use the chat box in the Q&A icon button on the bottom of your screen. But to you now, I'd like to ask about this whole stress, this five-letter word that troubles everybody, particularly teachers. What's your take and what's been your experience? Thank you Vasanthi. Thanks for taking up all those questions and thank you dear teachers for writing down your questions and asking your queries here. First, I would just like to say that there's an African proverb, it says that it takes a village to raise a child. What about a whole class of children? Teachers are single-handedly doing that, raising a whole class of children and hats off to you for being the amazing you that you are. And I think the first part of this webinar we had discussed that there are a lot of multiple causes due to which the teachers are stressed and I would just like to go over the cycle of mental well-being. So it basically starts with yourself. So self-care is very, very crucial, just like Dr. Leena already mentioned, Dr. Vidya also mentioned that self-care is the priority here. Then comes the well-being of your co-workers and that's important even more than students because many a times we see that multiple teachers are taking care of a class and if you're not on board with the whole process of dealing with the mental health issues, then it can become very taxing for the students. So the well-being of the co-workers then comes the well-being of students and I think it should be a matter of great priority for every class, every school. Include that as a part of the curriculum as a part of the day and in fact starting the day with something like a calming activity, starting the day with the calming cards, they're okay, let's just sit down, seat on the floor, put your hands on your eyes or just put your hands like this to some movement activities, breathe, count slowly to 10 and then great, great job done. We are going to have a good day, so positive affirmations. So starting the day on those notes and also the second thing I see there is a lot of stigma around mental health and people don't want to address it, people don't want to acknowledge it. Most importantly in a place like school where children are coming with a lot of baggage and issues of their own. So if I'm to look at two glasses here, one child who's coming with a lot of emotional, financial trouble from his home and his social environment, little trigger in the classroom might just send him or her over the edge and whereas a child who has a lot of resilience and a capacity to deal with much more stress, they can continue in a much better way. Same way with yourselves as a teacher, if you are yourself calm and if you're yourself, keeping yourself as a prior to your physical and mental health, you are in a much better place to deal with all the worries, all the issues that children are bringing into the classroom. So the mental health of students then comes the whole school wellness, that's again something that has to be given a priority from the top post to the lowest level and community inclusion. So parents have to be involved, professionals have to be involved. A lot of people have to be connected, it's not a one person solution. I was looking at the questions that a lot of teachers were posing related to addiction, whether it's internet addiction, substance addiction, initially the teachers had also mentioned, Ms. Manila mentioned, Mr. Alam mentioned that there are a lot of problems going on at the social policy level. So a whole system has to be involved, it's not a one person's problem or at individual level you solve what you can. Again, if I'm just to talk about the questions which are coming up, there are two approaches to this. One, I can be problem focused or else I can be solution focused. Okay, now I have a set of problems, but if I keep just standing and staring at those problems, it's not going to do anything to solve it. So I can just brainstorm as to, I have solutions, ABC, which I can do at an individual level and go ahead with that. So that is very important to understand that I have been dealt with these cards and how do I go about processing this. The other thing, like I said about self-care, so important for the teacher to take care of their own physical and mental health. Some things that you can do is, one Dr. Vidya already mentioned yoga meditation, start with that, always some form of physical exercise during your day that is very crucial, connect with other people, your colleagues or people around who are in your social circle, whom you can talk to, who can provide the source of acknowledgement, appreciation for you. So that is important, taking some me time for yourself, that is again very important, spending some time in nature and doing a lot of positive self-talk. So affirmations are very, very important. And like Mr. Alam mentioned that in their country, the teaching profession is not looked upon as probably a very prestigious profession. So it can create a lot of self-doubt and a lot of self-esteem issues for the teachers themselves. So give the positive affirmations to yourself first, believe in yourself so others can believe in you. The students are really looking up to you for the sense of acknowledgement that they need. So say that to yourself every day that I matter, I make a difference and I like what I am doing, I make a significant impact on the lives of so many people. So say that to yourself every day. So positive affirmations are very, very crucial. The other question that you mentioned was that students are very emotionally weak. I wouldn't say emotionally weak, the whole social environment has changed. There's a lot of social pressure on them, social media, internet, these things have contributed in a very negative way I would say, especially during the pandemic time when children had a lot more exposure to what they should not have been exposed to. So all that has actually contributed in a bad way to their growth and development. And even in the hospital we are getting a lot more teenagers in a way it's good that they're at least not denying the problem and they're coming to us at the right time. And the other thing is community inclusion, parents also need to be vigilant and I think it'll be a good idea also if somebody from the parent forum can also be included in these talks. So the more awareness we spread. Wonderful, wonderful suggestion. Yeah, so we work on three things whether it's at your level or at the student's level. I am, I have and I can. I am is your core beliefs about yourself that I am such and such a person. How do you define yourself as a human being and your potential for growth? I have means whatever resources you have in the physical space, whatever social support groups you have, which can help in improving your position from where you are to where you want to be. And I can is the potential for growth and improvement. I am, I have and I can. So goes from there to we, we am, we have and we can. So together as a collective effort, always a collective effort. Okay. In the classrooms, somebody asked, you know, how can we help students when it's talk about mental health? You know, don't just push it under the carpet. Don't, you know, stigmatize it. If somebody's coming to you, some student is looking visibly upset about something or if, you know, the common reaction to feeling low in students is they start acting out, they start throwing tantrums, they would start behaving aggressively. They would turn to a lot of substance use. So identify those red flags. If a student is getting disturbed in his classroom work, you know, there are behavioral issues that are happening. So it's important to talk about mental health in the classroom every day. Please spare some time and talk about it. And if a student is coming up to you with his or her problem, please listen and empathize, you know, rather than giving them suggestions, rather than dieting them immediately to some professional, just be calm and listen to the student when they're coming in, you know, disclosing a problem to you. That's the least we can do as human beings is just listen to another human being with some empathy. Okay. And many, yeah, many times that the problems get resolved because students just want to be heard. Even as a human being, you would like to be heard if you're having a problem, right? So that is very, very crucial to helping them. That's a very compassionate, let's say presentation of thoughts, the way you have put it, the need for the younger generation to be heard, the attention that we think we are giving them, but then that's so much kind of diffused in devices and so many other things. And also, you know, that whole three-step process that you spoke about, Dr. Shruti has been very useful. I'm sure teachers have made a note of this. Due to shortage of time, you're not able to take up individual questions, but I'm sure they will find a way to reach you. Thank you so much once again for this very pithy presentation, very much. Indeed. So after this view on psychology, it's only appropriate that we invite a doctor who will tell us about the cardiology angle, because emotions, the mind, the heart. So how is the heart fairing among teachers? Dr. Chirag, may I now invite you? He is a consultant in interventional cardiology, Manipal hospitals. So CVD as it gets called, the Cardiovascular Diseases. Now, so many statistics are showing an alarming increase in that, and I'm sure this is true across geographies and not just in India. So Dr. Chirag, when it comes to teachers and their heart, what do you have to say? You've been looking into hearts for such a long time. Yeah, good evening, everybody. So I was hearing about the stress and all the factors which teachers have to go through in their routine day-to-day life. So as Dr. Vidyadar put up in his slides also with the change in economics and everything, so I don't think anybody is immune to the changes that are happening as a whole. And the teachers as such also because of the stress involved are equally vulnerable to the heart related issues. And so a lot of it is said already, like how to prevent the heart attack, how to keep the heart healthy and everything. So if I can, we'll just share a few slides so that they can understand exactly what we mean by preventing a heart attack and what we also mean by coming into terms with a good heart health, okay? Sure. Thank you, Dr. Meanwhile, please keep your questions coming in on the chat box as well as the Q&A icon that you see on your screens. Due to paucity of time, individual questions we may not be able to take up, but there's always a way to have them addressed even after this program. Over to you, Dr. Are you able to see my slides? Not yet, Dr. Chirag. Meanwhile, there are more messages coming in even as Dr. Chirag gets his slides ready. As there is Harrison, who says it as teachers, can we get some videos on physical exercise that we can practice in the classroom with students. There's Shivaranjini Sai who says the children are not listening to parents and teachers. This is not a positive approach. And clearly this is something that also adds up to the stress levels. It's back to Dr. Chirag as we can see his screen now. Okay, thank you. So by heart attack, what do we mean? That is a one common question, because there is always a difference between heart attack, cardiac arrest and everything. So when we mean heart attack, what we exactly mean is that one of the arteries which supplies blood to the heart is getting blocked. And as a result, the muscle which is supplied by that particular artery is undergoing damage. To put it brief in anatomy, the heart has two blood systems, one on the left, called the left main coronary artery which divides it. The slides are not moving, Dr. Chirag. The slides are not moving, Dr. Chirag. We now see only the main page with the title. Do try clicking on the yes. Now? Yes, now we can see your slide. Okay, sorry. So are you able to see it move now? Only on slide two, but I think you may have to manually do this because we don't see any other movement. Are you able to see it now? Yeah, we can see slide number two. Yeah, the third slide. Yes. Okay, we'll do it this way then. So it divides into two systems, the left and the right. The left has two more branches called the left anterior descending, the left is complex and on the right. So what we mean by heart attack is when any block develops in one of these three arteries and if the block is significant enough that it is causing reduced blood supply to that particular area of the heart, the muscle which is being supplied under both damage and that's when we call it as an heart attack. So when you see a cross section, this is a normal artery wall which is very clean with no deposit of any cholesterol or anything. So as the fatty deposits due to the cholesterol, especially the bad cholesterol in the form of LDL builds up, a plaque develops. This is the reason why blood flow gets impeded. So eventually it progresses in severity and initial symptoms when they're around 80% blockage or 75 to 80% blockage. Initial symptoms will be like when they do too much work or stress themselves, they'll develop pain. But when it becomes completely blocked like here, it can be a slow progression or a rapid progression when the clot develops on a pre-existing plaque, then the blood flow to the entire system is cut off and that's what leads to an heart attack. So if you can appreciate in this small animation, the particular block is in this particular artery and this artery is supplying blood to this entire area. So what happens is when the block is severe and it is causing complete occlusion, the entire muscle undergoes damage. So how do we treat that is to relieve this block and re-establish the blood flow. That is the best form of treatment. It can be done with injections or if they're in a facility where they can be treated by intervention like angioplasty, they can undergo angioplasty and if the block is relieved early and well within time, the muscle which is undergoing damage can be salvaged very well. And in coronary artery disease it's a major health challenge and we are seeing across a spectrum in all the developing nations and it is attributable to the changes in lifestyle and economic development. It is on decline a little in the west because of the awareness what we are seeing and the enormous health education which they have. And when by what do we mean by an angiogram or an angioplasty we do to relieve these blocks. Basically it involves introduction of a catheter either through the hand or through the groin and we basically put this catheters into the heart and inject dye into the blood vessels to locate where exactly is the block and if at all we find a block we have to clear it. How do we clear it? This is called a procedure called angioplasty. We put a wire across balloon and then followed by a stent so that the blood flow is restored and the block whichever was causing the block and reduced blood supply to that particular area is completely relieved. In people who have multiple blocks the other option is to undergo a bypass surgery. This is not done in the setting of an acute heart attack but after stabilization. So when do people develop symptoms of heart attack whether do they develop within 24 hours one week prayer or one to four weeks prayer. So few percent of the patients like around 30 percent have some of the other symptoms going on for few weeks and typically these symptoms are ignored and thought of due to other reasons and not taken care of. In other majority of the patient the symptoms starts two to three days prayer and in about 10 percent of patients especially younger individuals where clot is the main reason for heart attack the symptoms are very acute in onset. Can it be prevented? Is it a myth or a reality? It is a reality because it all requires is taking care of the risk factors which control which are responsible for the heart attack. Briefly going through them cholesterol abnormalities, mocking, diabetes, hypertension, obesity and lifestyle. Coming to the cholesterol two things we need to know in brief is the LDL which is the bad cholesterol and HDL which is the good cholesterol. So very high amounts of LDL are seen especially in people with poorly controlled diet who have a family history of hypercholesterolemia and are known to have a lot of red meat. And there is some genetic abnormalities which is also associated and they tend to have a higher cholesterol concentration when compared to the other routine population. Tobacco, tobacco is one of the most important reasons and it's the most common reason why young people develop heart attack. It is associated with all the increased risk factors like it reduces the good cholesterol, increases the bad cholesterol and it is associated with the higher blood pressure and it increases the tendency to form clots. Diabetes and diabetes is also a very significant contribution especially in people who are already smokers age and diabetes also contributes to all the factors which lead to heart attack in the form of atherosclerosis, clotting and hypertension. The other common risk factor is the obesity as previously described due to the sedentary lifestyle we do see a lot of patients coming with obesity and now with the increased awareness they are also into a lot of exercising and dieting to help reduce the obesity but we should accept that obesity is one of the major risk factors which is resulting in heart attack. And lifestyle especially when the amount of stress at work is too much associated with hypertension and mental stress and also anxiety can lead to increased stress on the heart. Alcohol when used in moderate to mild amounts once or twice in a week with small amounts can be okay but it's very rarely seen that people stick to this limit and usually it is associated with increased use of subsequent items like tobacco or other unhealthy eating habits leading to increased risk of developing heart block. So other factor what we are seeing recently is the incidence of sudden cardiac death. The most important cause for sudden cardiac death remains heart attack but we should also know that there are many other factors which can lead to sudden cardiac death in the form of arrhythmias or cardiomyopathies which may put a patient at risk for sudden cardiac death but the most important risk for sudden cardiac death is still due to a heart attack. So what are the prevention tips? The most important prevention tips is to modify the risk factors where we should actively look for it and if we see that there are risk factors we have to modify them properly, regular exercise, diet and de-stress. So smoking there is no alternative, a complete cessation of smoking is the only therapy. Hypertension it should be brought under control and brought under control well within the range of 135 by 85 or 130 80 or even lower in patients who are diabetic and body weight as we have discussed there is no other go than to adopt a healthy eating habit. So what are the now other common thing we are seeing is people who are using gym and developing sudden cardiac arrest and the people who are not habituated to exercise developing all sorts of symptoms. So what are the rules to minimize the risk is always warm up and cool down and it is necessary that we train regularly and we should avoid excessive peaks and if any symptom should be reported and should be thoroughly evaluated before continuing with the routine exercise. And diet I think a lot of emphasis is on diet these days and so best way is to keep the quantity of oil to the bare minimum, avoid cream of milk, avoid when it comes to the non-vegetarian items to avoid red meat and organ meats and include a lot of green leaf vegetables, vegetables, sprouts and legumes in the diet. So these are the basic guidelines where we can maintain a good healthy diet which includes including plenty of fiberage to fruits, take a lot of salads and fruits and use minimum amount of oil and substitute fruit juices for coffee and tea. So that should be it Vasanthi we can take any questions or if we have time or anything we want to discuss we can discuss. Yeah Dr. Chirag, within a very short duration you've covered quite a spectrum of what really leads to a heart attack, what can people do and why to repart. There's time for one question and I would like to ask it on behalf of Frederick Indala. He says that do medicines like Ator Vastatin help to reduce bad cholesterol in the arteries? Yeah like it is the treatment of choice to reduce the blood cholesterol like there are two statins one is called atroastatin and the other one is rose. Dr. Chirag are you yeah are you able to hear? Yeah yeah yeah. Yes Dr. you were saying about the drug. Yeah so we have two medications like atroastatin and rose was statin being recorded. Sorry I think there is some problem with the drug. Okay yeah so you can hear me now. Yes I can hear you even if there's no video that's okay Dr. Yeah so the only issue is these statins are necessary only when the lifestyle modifications like diet and exercise have not been good in controlling the cholesterol levels usually it depends upon the other risk factors if somebody is a diabetic we have a lower threshold to set them on tablets. If it's an young fellow a young young patient around 35 years who comes with a high cholesterol we always unless it is very high we always tell them to give lifestyle modifications like diet and exercise a chance and only when that is not able to control the cholesterol to the optimal levels we can always use atroastatin or any other statin and a lot of medications are available to control the statin to the optimal level but the first step in a otherwise healthy patient would be to avoid or adapt lifestyle modifications and if it doesn't work then medications can be used. I hope that answers your question Mr. you know Frederick along similar lines Edward Banda says that some of the healthy issues pertaining to the teaching profession include heart attack, hypertension, asthma. Now what are the cheapest ways of dealing with these challenges? I think you've spoken about lifestyle changes it probably means getting back to the basics. Like what is the I didn't get your question sorry. He wants to know what are the cheapest ways of dealing with these health challenges because healthcare I'm sure in the geography that he comes from including countries like India and Bangladesh very very costly so he wants to know what are the cheapest ways to get treatment for the problem the teachers face health problems. So there is nothing like cheapest it is the best thing would be to identify the heart attack and treat it early so what happens is when the heart attack is treated early we can reduce the damage that the heart attack causes to the heart so go to the nearest facility where no not necessary that every facility where they do only the angiogram angioplasty even if it's in a remote place if they can identify that the patient is having a heart attack and the initial treatment is started with some blood thinners or thrombolytic agents that is with the best way but the most important focus should be to get it treated early so that the long-term effects of heart attack like underlying heart damage and heart dysfunction can be prevented that is the most important thing. Right thank you so much Dr. Chirag thanks for all the points. Thank you thank you. I know that there are more questions coming in I can see you know the in the chat box as well but let's go across to the last speaker of the day Dr. Navin Chandra because one thing which is probably essential to inculcate and include in training programs at a school level to students is the is a technique of CPR some countries one years already this is happening but may I invite Dr. Navin Chandra now to share with us more on how actually this the CPR training and what exactly is that so welcome to you Dr. Navin Chandra not able to hear you no no Dr. Dr you're on mute Dr. Can you hear me now very clearly okay sure so thank you for this opportunity and I'm Dr. Navin I work in Manipal Hospital Vartu Road it's a very it's a very important topic you know Cardipal I have no slides but I'll demonstrate for the viewers so please do yeah see the CPR first let me tell you what is CPR CPR is called cardiopulmonary resuscitation now you'll have to know certain things about CPR one is what is the basis of CPR and now you you would have seen a lot of patients suddenly having sudden cardiac death you know losing consciousness and falling down and you know dying within minutes of falling down some people would have died in sleep this is this is something called sudden cardiac death or that's because of cardiac sudden cardiac arrest now there is a difference between cardiac arrest and heart attack now cardiac arrest is basically a sudden cessation of all heart activity now heart attack is one of the commonest reason for cardiac arrest but it's not the only reason it can be because of multiple reasons now heart attack and cardiac arrest is not synonymous there are two different things a person has heart attack you can go to hospital he doesn't mean that he will be unconscious or something you can go to hospital take the treatment etc a person who has a cardiac arrest that means his heart has stopped functioning heart just stands still there is no activity of the heart so when there is no activity of heart what happens there will be no blood pressure no pulse there is no blood which is going out of the heart is basically a pump which pumps the blood out of the heart to the different organs of the body now it stops functioning that means what happens there is no blood which is going to brain any all the organs of the body and when the blood doesn't go to his brain he lose consciousness and fall now this is called cardiac arrest that means the person's heart has stopped functioning now when a person has a cardiac arrest now whatever may be the cause it may be congenital cause heart rate abnormality heart attack whatever is the cause whenever a person has a cardiac arrest he has few minutes not even you know some people may have seconds or maximum few minutes if something has to be done it has to be done within few seconds or few minutes after that even if you do anything if you I mean if you even get him out of that position it is of no use because the problem is brain in CPR cardiopulmonary research it's not the only the heart we are worried about it's the brain now brain cells will not survive without oxygen for few minutes now if the brain is devoid of oxygen for few minutes the brain is going to have a irreversible damage even if the patient is revived post that if his blood blood pressure pulse comes back he's going to be branded so it is of no use so it is the brain as well as the heart we are worried about when you're doing a CPR you are doing a CPR to keep the circulation on for the brain to have enough oxygen to survive that period it is not only the heart see kidneys liver all the organs can survive without you know blood for many hours it can regain it but brain is only few minutes so when a person has a cardiac arrest we are talking about few minutes or few seconds so we'll have to act very quick now there are few basic fundamental questions one how do you know a patient has a CP a patient need a CPR or a patient has a cardiac arrest now a person of the cardiac arrest how do you identify is basically a lack of responsiveness lack of consciousness the patient is unconscious there is no response is one of the same but that can be there in multiple other issues a person has stroke person has low sugars person has low blood pressure also can lose consciousness but there should be no loose if there is no consciousness there is no breathing there is no circulation these three things are telltale signs of cardiac arrest one is you you know you'll try to wake him up he's not breathing you see his breathing pattern he's not breathing you can check his pulse which I'll demonstrate which is check his pulse there is no pulse these are the three things you see that means the patient is in cardiac arrest now when a patient is in cardiac arrest start your CPR now there may be confusion whether his pulse is felt or not felt you know he's lost consciousness he's not breathing maybe pulse is there or not when in doubt start CPR there is no harm you're not going to harm a patient by doing a CPR you may break one or two if you're doing a very you know very forceful CPR but he's not going to die so when in doubt you can actually start the CPR so so first we have to identify when a person requires CPR so three things lack of sensorium a consciousness no pulse no breathing okay now when do we start CPR CPR has to be started as early as possible within few seconds you see a patient lying down if a patient has no sensorium no breath no the sins of love immediately start there's no nothing to wait for because as I said it is not minutes it's seconds which comes there are instances where a patient has you know had a cardiac arrest just outside our hospital within 50 meters by the time they reach the hospital they would have been blinded so it is a minute not even minute seconds you see the patient you immediately start the CPR so first question is how do you determine the patient has a cardiac arrest second is when do you start CPR the third is what is the basis of CPR see basis of CPR is you are compressing the chest for the you are basically compressing the chest so that the blood the you are compressing the chest in in in doing that you are basically compressing your heart when you're compressing your heart you are basically pushing the heart to push its blood from the heart to the other parts of the body okay every time you push the blood goes out of the heart basically you are you know massaging your heart your pumping you are making the artificial pumping so that the the blood is the flow is established to his brain practically its brain okay now let us let me demonstrate how the CPR is done and how do you you know do a CPR and how long to do etc okay visible yes okay yes doctor we are able to see can you see now yes doctor now let the patient has lost consciousness and fallen down the first responder is his best choice you know you cannot call somebody who is outside come and give a CPR you know he is in outside somewhere you know you cannot do that so that's the importance of knowing the CPR CPR is a very basic life skill as you know swimming as you know driving CPR is a very basic skill because you don't know when a person is going to have a cardiac maybe at home it may be at work it may be a you know kid it may be anyone I had I know I didn't get my PPT I would I would I would love to have shown that there was a kid who developed a cardiac arrest a teacher you know learned the CPR a day before you know there was a CCTV footage you know the CPR the teacher gave a CPR for 10 to 15 minutes and saved her wow it is the first responder which matters that's the reason we're trying to you know tell everybody to learn CPR because you don't know who will get you who will read it you know somebody you yourself may read it you know the best chance is the bystander so you try to wake him up he's not waking the check is breathing he's not breathing check his pulses which is character this is the best pulse you can see just you know around the neck you just check his pulse pulse is not fed start the CPR now in CPR your hand should be placed in between the nipples in the middle of the chest okay this is where if you can see here this is where the heart will be so this is where you have to press okay now you keep one hand the the the palm of the hand in between the nipple the second hand over it okay and we try to push it now when you're pushing you have to understand that this has to be in a straight line you cannot just like this this is wrong yeah yeah can the camera please still down yeah that's wrong okay now this is wrong because your elbow has been bent and this one is bent so it has to be in a straight line this is how it is so the whole disjoint disjoint disjoint has to be the straight line so if you cannot get then you get on to the table because you cannot do like this so you get on to the table doesn't matter so you keep one palm here one palm over it you start pressing okay now if the press should be it should depress the sternum by one to two inches I see now let's say I am doing less what happens that means you are not you know you're not reaching the heart the the idea is to when you press the heart is you know the heart is pressed so that it is emptying its blood to the outside of the body so if you're doing like the heart this this is inadequate and if you do forcefully what happens you're going to injure the ribs okay now that much is not required the force should be around one to two centimeters this is the force now if you if you were given a choice you can do more forceful than less forceful because more forceful is fine nothing will happen patient may break one or two rib but nothing is going to happen he's going to survive but if you go less then there is ineffective CPR he's going to be dead it has to be an adequate number of pressure and how much to do it should be around 100 to 120 per minute okay this is the speed 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 19, 20, 21, 32, 23, 24, 25, 26, 27, 28, 29, 30 30 is one cycle when you do one cycle if for mouth to mouth respiration somebody wants to give they can give two breaths but it's not mandatory in our general public we don't accept them you know you could put a kerchief and give a mouth to mouth closes nose and you can give a mouth to butt but it is not mandatory just do a just compression is enough if you're tired ask your colleague to come so every 30 if you're tired you can you know come ask your colleagues to come in continue the CPR now another very important is that you cannot why are you not doing forcefully the thing is you need when you're pressing it you have to release it as well okay you cannot you know just do like this what happens when the idea is when you're pressing the heart is empty when you release it heart is basically it relaxes so that it fills itself okay it has to fill back now if you're doing like this you're going to just press an empty heart so when you press heart is empty when you release the heart is filling up okay so you continue to do that so you continue to do that until 100 to 120 per minute 30 is a cycle okay and if possible every 30 cycle you can do two mouth to mouth respiration okay now this is about CPR now how long to give it this is the second question how long to give it so first thing I forgot to tell you that when you start a CPR the first thing what you want to do is get a help calls I've asked somebody to call for an ambulance because you cannot do it for long so first thing is call for help which may be a ambulance or a hospital doctor or somebody nearby whatever it is get in help call the ambulance and start doing the CPR now till when you will do CPR now CPR is done to maintain the circulation so when you will stop when the circulation starts back unless a patient gets up let's say he gets up or his breathing starts back or you are checking his pulse once in a you know cycle the pulse is back so that basically his circulation is back you can stop the CPR second possibility is that a help comes in a doctor comes in an ambulance comes in there in a better equipped to do you know advanced life support there's something called ALS which is advanced life support that we are we need certain things for that so we can continue that but there are instances where people are given one cycle of CPR and get the patient to the hospital you will be dead by then so it is of no use if you don't do continue a CPR there are instances in hospitals where you have done CPR for one hour half an hour to save a patient until his heart starts back so until his heart is working you have to do a CPR or when the help arrives you have to do CPR so a lot of people do one cycle and stop it that doesn't matter that has no value it's actually counter product so you will have to do CPR until there are signs of life comes back or a doctor comes back or a help comes back okay so if this is very very important it can save a number of lives because it is not minutes as I said it's seconds which what matters every second matters okay so every minute you when the patient has a cardiac arrest one minute if you are sent spent without doing any CPR his chance of survival is going to come down with after five minutes it may be less than 10 20 percent so that's the reason early initiation of CPR is extremely important because if somebody has a cardiac arrest you are I mean the best chance is by standard for survival we are interested in instances you know a person who has learned to CPR and you know given a CPR and saved people like that so it is it is it is unheard in western population we do a lot of people you know a lot of people know CPR and they're in a better equipment for the situation I was going to ask you that Dr. Naveen Chitra my question after this absolutely crucial demonstration that you have given and as you rightly say CPR is a life skill just like how we learn driving or swimming absolutely yeah yeah I was about to ask you one years I'll give you a very simple example in marathons there are people used to you know have cardiac arrest you know they say when you have a cardiac arrest in a marathon your chances of survival is better when you are having a out of hospital because there are people who are trained to give you a CPR there are these paramedics sitting there in west right I have seen and a lot of my friends have seen you are one of my friend is there he's a doctor he says that if I have a cardiac arrest in UK he stays in UK he said I will probably survive in roadmap because most of them know CPR actually they're aware of CPR so he said somehow they'll take me to hospital they'll give you a CPR and that is a statement he gives me he's worked in here and he's worked in UK right yeah the penetration of CPR knowledge is not very great I would say yes so what can we do I mean we have people we have teachers joining in from Bangladesh from you know countries I think it has to be made a curriculum see the only way to teach people is in children whatever we learn as a child it stays with us for a longer period of time than when we you know try to learn kids are more receptive right for learning you know larger gatherings like corporates we had a you know CPR classes for gym trainers because the lot of people in the gym has cardiac arrest we had a trainer for training for gyms actually gym trainers sports trainers you know that's very essential skill and you know maybe corporates we even planning to you know as a security you know securities of the apartments right they are the people who will be there all the time yes you know if somebody has a cardiac arrest in the building they can go and actually give CPR and start the so we'll have to target such individuals we have this we have this teacher from Bangladesh Mohammed the alum you've been listening in to what Dr. Navin Chandra was saying do you think that something that you know even schools in Bangladesh can take up I mean if if teachers like you and the association would represent actually push for this it's just like saving we also have a head of teachers association from Malachi Edward Panda I know I'm coming to him but I saw that Mr. Alam was you know very keen listening his video was on so I wanted a one yes what is ma'am yes ma'am am I audible yes okay so it is a very good question ma'am actually it is the matter of policymaking from our government of Bangladesh because in you know in our country okay the lack of doctors okay is very crucial okay problem okay because in proportion to our total number of population our doctors are very few but since we have a doctor's problem so we have to our government from our ministry of health okay they should think about this in in in the in in the an education ministry they should okay with alignment with the health ministry they can okay make a proposal to the to our parliament yeah to up to parliament to make a policy okay that in school college or different institutions or corporate level okay this kind of practice okay should be developed in future okay but Mr. Alam I'm so sorry I'm so sorry for interrupting you because of shortage of time yes at the policy level it's very crucial but I hope even at an individual level from what Dr. Navin Chandra had demonstrated you think it's doable by from at an individual level people and teachers and students yes ma'am it is possible but we need practice we need training okay so who will train up that is the problem okay so we need good trainers okay so in in our country okay so CPR actually some doctors okay even some junior doctors who who cannot okay give a CPR to the patient I think from my experience I have found many doctors okay junior doctors they sometimes they feel very afraid okay to give CPR to the patient and they they refer to the patient to the senior doctors but senior doctors are very much busy with their patients lot of patients okay so in that case okay so general people for general people okay it is very tough to give CPR okay basically any school or college level okay but but if proper training is okay given to the teachers or to the other personalities okay to give CPR or to many sudden problem of cardiac arrest then it is possible but I think it is it will take long time okay yes you know you have shared very a realistic picture of what's on the ground at the same time I'm sure you know these things will have to move from individual to the to the administration levels yeah for sure thank you so much for your inputs before we move to the last as you know I would like to invite Mr. Edward thank you thank you Mr. Alam once again but while I invite Mr. Banda I would just like to acknowledge the messages of Shibir and Ginny Sai a teacher who says that it was very informative sir thank you for this demonstration of CPR which also Frederick and Allah who says can you repeat just where to detect a pulse the other parts I think were clear but how does one detect a pulse yeah see the simplest ways of course you can see the radial pulse but it may be difficult to feel the radial pulse the best way to see is the jugular pulse so just the neck side of the neck just press it to the side of the neck you can actually feel the pulse yes yeah that's a very simple way just the root of the neck just press it because it's three four fingers definitely you're going to feel it's very very easy another thing I want to say is CPR is a very very simple very simple technique even a you know three or four year boys when we go for a training they learn within no time we just need to sim basics and probably spread the knowledge spread the you know importance of it and give life examples how people have survived such things then it makes a lot of difference actually it's I think in today's digital age doctor for places that don't have good doctors maybe from a credible source videos that are online let me tell you one thing most of our CPR training we don't go our ambulance drivers do CPR training our paramedical staff is good enough to give us CPR training our ambulance driver our ambulance mass ambulance staffs are so good in CPR they do most of the CPR training so it is it is it is absolutely do you don't need a doctor to train CPR actually thank you thank you very simple technique yes doctor would like you to stand by while I invite Mr. Edward Banda from Malavi on video if you can join us at this moment Edward Banda because we would love to can I just say something Vasanthi I was clearly listening to this you know I think Dr. Navin we must you know spend this about you know everyone should know CPR I think we really need to take it to the community level absolutely yeah it's very great that we have you know the you know the teacher community with us right here but I really think we should take this really really we must take this I think this is most most important like you remember we used to say that if a patient reaches the hospital alive then there are more chances that we are going to be able to do something but if the patient you know whether it's at home or in the workplace they're not able to do you know the CPR you know a simple example ma'am recently we had a you know he there was today he came for a follow-up he had an MI and a cardiac arrest at home his wife gave CPR wow she gave she survived he came to hospital we did an angioplasty he survived I keep telling you over your life not to me to your wife correct correct you know another thing now the basic thing like when you were showing the CPR being performed I know so you know someone I mean we were called there were our neighbors and we had gone in to do a CPR sudden collapse after a hearty meal in the night and I remember they were doing it you know while the while the gentleman was on the sofa you know the soft this thing people are going to bring him down on the floor and have a hard backup you know hard so these are small things actually for a proper CPR absolutely yes very nice bringing this to the notice because even I watching the demonstration felt so suddenly you know you feel empowered that you have actually within you you don't need to wait for a doctor to do this preliminary response to save a life once again I'd like to thank Dr. Naveen Chandra and Dr. Leena Shridhar Mr. Edward Banda so what have been your takeaways you've been with us in this very special International Teachers Day program a lineup of doctors are shared how health challenges of teachers can be addressed what did you take away from this we are unable to hear you Mr. Edward Banda because your video is on mute well yes now we can your audio is on thank you very much I welcome my clear that we have this meeting returning to our teaching profession Mr. Banda your your your audio is not clear may I request you that you try with the video switched off I mean if there is very limited bandwidth or network maybe it'll help if because we are not able to hear you the voice is garbled no there's a lot of disturbance in the air the moment starts with hello Sandeep can switch off his radio and then yes if you can yeah the video part if you can switch off only your voice can be on that might make it clearer can you get me now yes very clearly please go on I say as already been said my name is Edward Banda from Malawi Central Region Salima as a district yeah it's very it's has been a very good program I mean a meeting that is the highlighting some of the health issues we teachers face across the continent across the other continents across the the globe rather now we have learned so much especially from different doctors highlighting some of the problems the causes how can you overcome those problems say for example heart attack cardiac arrest have been highlighted so I think we have gotten much of the information from our respected doctors that is a very wonderful job I should not take a some of the problems we do face as I said by my colleague is overcrowding so out of overcrowding we do face a lot of challenges right yeah thank you so much thank you Edward Banda despite the place where you are in it's probably the network is having some glitches but we could hear you loud and clear when you express your feedback we are really glad that the sessions by various doctors have been useful for you they connect to what's happening in Malawi you spoke about the central region where you are and that's exactly what would make this program purposeful the organizers from Manipal Hospital the team have been at pain to organize things which are of relevance which actually provide practical tips in this case to a community of teachers worldwide and to make sure that you are empowered with information at least you know and you have the first response to many of these things you've learned many tips from the best of the doctors here with that we come to a wrap of this program it's been very you know food lots of food for thought I would say and then especially going even by the questions when you ask the questions and then the responses came then our collective learning increased and that to me as a journalist is really good news because often we tend to skip these things don't we I mean we don't really take ourselves or our health care very seriously it's always happened to someone else but not us yes yes Dr. Lina so it's time after almost let's say two hours 120 minutes that we have spent all for life saving tips may you always have good health dear teachers may you have great you know mental health scenarios among your students among your families the work banners that even Dr. Lina and other experts shared have yourself a wonderful teacher's day internationally thank you for who you are thank you for makers who we are and on that note I Vasanthi Hari Prakash sign off but then this is not a conversation that's ending here please find each other on social media let's stay in touch and with that I hand the floor back to Dr. Arun thank you and namaste namaste thank you all doctors and thank you Vasanthi for your wonderful show and I request all the teachers they can pose their questions here we can send back to them the answers with the doctors suggestions thanks a lot good evening from India and of course for whichever whatever time zone you are in have a great day bye bye bye